Published on 5 March 2026

The consultation room where I work is often “deurmekaar” — cluttered and chaotic. Next to my computer screen sits a towering pile of unattended patient records. Papers are scattered across my desk.

My next patient, in contrast, is immaculately dressed. She places a neatly handwritten page in front of her — a list of concerns, each item carefully marked with a bullet point. I find myself wondering what she thinks of the mess on my desk.

She was recently investigated at our district hospital for gastro-intestinal bleeding. A biopsy was taken to exclude cancer. In the meantime, she consulted a private physician for a heart complaint.

Perched on the edge of her chair, she methodically works through her list. I gently interrupt and ask permission to read the physician’s detailed report and review the histology results.

Her understanding is that she has cancer. The histology report is highly suggestive of malignancy, but not yet definitive. Another procedure has been scheduled at the referral hospital for further evaluation.

She is reluctant to go ahead with this procedure.

She lives alone and relies on friends and neighbours for transport. She does not want to burden them further. She is also concerned about the anaesthetic risk of the procedure because of her heart symptoms. She describes her palpitations in detail, unconvinced by the reassurances in the physician’s report.

Yet she has requested a CT scan of her brain to exclude the spread of cancer.

I notice my reaction — surprise… perhaps even irritation. Her reluctance to have the procedure  contrasts sharply with her request for advanced imaging. I would like to explore this with her further.

At the same time, I am acutely aware that the waiting room is still full and the afternoon is slipping away.

Uncharacteristically, I become more directive.

“I think you should go ahead with the procedure. The light anaesthetic is unlikely to pose significant risk to your heart. It will provide a definitive diagnosis and guide further management. With that information, you will still be able to decide how you wish to proceed. I strongly advise you to go ahead.”

She seems partially convinced. I leave the final decision with her.

Afterwards, I reflect on my more directive approach rather than a more explorative one. What shifted in me?

Was it the pressure of time?
Was it her detailed recounting of symptoms?
Was it her ambivalence?

Or was it my own discomfort with uncertainty?

Clinical encounters often mirror back our own vulnerabilities — about time, control, responsibility, and outcomes.

Sometimes the most important part of a consultation happens after the patient leaves the room.